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nkarman
Instructor
| Joined: | Sat Jul 15th, 2006 |
| Location: | New York USA |
| Posts: | 12 |
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Posted: Thu Jul 31st, 2008 02:47 am |
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OK, I finally got back on to respond to this again...
BOTH NDT AND PNF are facilitation models, in which a peripherally applied stimulus is designed to promote a specific motor response (bottom-up models). This is in contrast to a "motor control" or top-down model in which the person must problem-solve and respond to environmental or task constraints/conditions.
I am a bit tired of the stranglehold that NDT (and, to a lesser extent, other facilitation models) have on neurological intervention, particularly in pediatrics, despite a real lack of any sort of research data to support their use. I just finished reviewing an article (Cherng, et al, 2007) for an upcoming training, and (although it was not a focus of the article at all, not even discussed) I think that the (granted, very limited) data supported the use of BWSTT over NDT, and even suggests that NDT was ineffective. I was disturbed that even during the “experimental” intervention period, NDT-based intervention was included (the conditions were “regular treatment” and “BWS + regular treatment)- implying that BWS gait training as a stand-alone intervention method would be inadequate. They used outcome measures that appeared to have been selected to be sensitive to changes being “targeted” by “regular treatment” and there was no significant change in those measures for either condition (crossover design).
I would argue that “therapeutic events” can take place absent hand placement on the therapist’s part. An action can include environmental manipulation (of any condition), or even providing a visual or auditory cue to vary performance. Providing targets or cues that focus on results rather than performance can actually yield superior outcomes.
Patterning and facilitation in a BWSTT system can be different from each other. Patterning is essentially passive in nature, whereas facilitation (using a broad, bottom-up model definition) can still require an active response. I would argue that both are of limited value, with the passive performance of lesser/no value (other than, perhaps, maintenance of ROM).
The argument you make about evoking a response via disturbance to the system would promote a “hands-off” approach in BWSTT. The treadmill itself (manipulated through belt speed, incline, etc) is the disturbance- no need for hands.
Last edited on Thu Jul 31st, 2008 02:50 am by nkarman
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WebKeeper
Administrator
| Joined: | Wed Jul 5th, 2006 |
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| Posts: | 60 |
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Posted: Sun Mar 11th, 2007 05:07 pm |
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There is no time limit on active sessions. There was a 15 minute inactivity time limit during editing. That has been raised to 60 minutes. But that applies to an open posting edit/reply window with no keystrkes.
I suggest for lengthier replies to do so in Word or Notepad (word processing software) first and then cut and paste it to the Posting editor. That way if it takes you time to form your response you do not lose anything.
The Instructors can also edit their own posting for a day after they post it. So you could add to or change what you have posted
Happy Posting
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nkarman
Instructor
| Joined: | Sat Jul 15th, 2006 |
| Location: | New York USA |
| Posts: | 12 |
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Posted: Thu Mar 8th, 2007 12:51 am |
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AARGH- I wrote a long, detailed response, and the thing timed out when I sent it to post, and now it is LOST IN THE ETHER. Can you increase the time on this thing?
NK
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Andrew M. Ball, PT, DPT, PhD
Instructor
| Joined: | Tue Dec 26th, 2006 |
| Location: | Charlotte, NC |
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Posted: Tue Feb 27th, 2007 02:46 am |
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Amir,
That's a great question of treatment philosophy. . . but in practical practice, the lines are a little more blurred than that. In short, I'd agree with the idea of manipulating the environment, though not quite for the same reasons suggested. It's hard to have this kind of discussion in terms of integration of NDT vs. PNF, with BWSTT . . . because the lines are being increasingly blurred. Though a SWEEPING GENEREALIZATION, "old timers" usually think of NDT techniques as those that help a patient through a movement pattern, and PNF techniques as those in which the patient reacts in a specific manner in response to a therapist evoked action.
That said, I learned quite a bit of the latter during NDT training in Lois Bly's course (e.g. a TON of PNF that, at the time, I and others would certainly, and in error, have assumed was strictly NDT), which personally, I find much more applicable to treating a child in the LiteGait system. That's my opinion, based upon the suggestion of evidence mind you, that one of the more valuable aspects of BWS-TT systems is increased frequency of "therapeutic events" in a treatment session vs. traditional therapy. I define this as a therapist (or gait-trainer) induced action followed by a patient reaction.
I don't see much value to patterning, which is essentially what facilitation in a BWSTT system is. I've not known any Mobility Research presenter I've known to disagree with that position.
Just as one of the primary treatment values of NDT is, in my opinion, less the patient's conforming to a facilitated movement pattern and more response to an evoked balance disturbance when on a therapy ball, so is the case in the LiteGait --- where one of the primary treatment values is the ability of the patient to make rapid equilibrium responses to evoked disturbances. It is my understanding that FACILITATION of the child's hip through the swing phase is not only NOT what's taught in the NDT curricula (certainly not in mine, as that would result in a "John Wayne" gait) --- but when applied to a child while walking in a BWSTT system, would diminish the outcome effectiveness of the system borne from the dance of evoked disturbance/patient response.
Sounds like a good study . . . but like I said, it's VERY hard to distinguish the two. If I had to say, I'd agree with the therapist you spoke with and submit that a "evoke and patient reaction" approach yields better results. I'd add, however, that way, way, way, too many therapists assume, in error, that the LiteGait is a facilitation (rather than reactionary system) and avoid using it out of hand. Technically it is neither . . . it is the THERAPSIT that works in a facilitation (less effective) or "evoked disturbance" (more effective) manner.
Drew
Last edited on Tue Feb 27th, 2007 03:01 am by Andrew M. Ball, PT, DPT, PhD
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amirseif
Super Moderator
| Joined: | Fri Jun 2nd, 2006 |
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Posted: Sun Feb 18th, 2007 11:52 pm |
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I just came back from what has to be one of the best CSM conferrences ever. Not only the crowds were there, the quality of the discussions were very high. There was one conversation specifically that I would like your comments on.
Someone suggsted that she would rather the environmrnt was manipulated to cause the patient to practice gait rather than facilitate the movement. She distinguished between extending the stance by preventing a quick step and facilitating at the hip to cause a more normal swing. In one the motor plan is by the patient's, in the other the clinician "interfers" with the motor plan. The dependency on that correction was part of the objection to facilitation.
What do you all think?
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